House Committee Substitute

HOSPITAL INVESTMENTS AND SERVICE AREAS (Sections 96.192, 96.196, 206.110, and 206.158)

This act modifies the investment authority of boards of trustees of municipal hospitals in third class cities and hospital district hospitals. Current law permits investment of up to 25% of funds not required for operations of the hospital or other obligations. This act permits investment of up to 50% of funds not required for operations or other obligations in a manner described in the act, with the remaining portion to be invested into any investment in which the Treasurer is allowed to invest. These provisions shall only apply if the hospital receives less than three percent of its annual revenues from municipal, county, hospital district, or state taxes or appropriated funds from the municipality in which such hospital is located.

Under this act, municipal hospitals in third class cities may operate in areas where hospital district hospitals and county hospitals operate. Hospital district hospitals may operate in areas where municipal hospitals in third class cities and county hospitals operate.

These provisions are identical to provisions in SCS/HCS/HB 943 (2025) and provisions in SCS/SB 317 (2025), and substantially similar to SB 244 (2025).

EMERGENCY SERVICES (Sections 190.053, 190.076, 190.098, 190.101, 190.109, 190.112, 190.166, and 190.800)

This act modifies training requirements for members of an ambulance district board of directors. Under this act, board members shall complete three hours of continuing education for each term of office. Failure to do so shall result in immediate disqualification and the office shall be vacant until filled.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), a provision in SCS/SB 317 (2025) and substantially similar to a provision in SB 548 (2025), SB 7 (2025), SB 206 (2025), SCS/SB 1382 (2024), and SB 1340 (2024).

Under this act, each ambulance district shall arrange for an audit of the district's records and accounts every three years by a certified public accountant. The audit shall be made available to the public on the district's website or otherwise freely available by other electronic means.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), a provision in SCS/SB 317 (2025), SB 548 (2025), SB 7 (2025), SB 206 (2025), SCS/SB 1382 (2024), and SB 1340 (2024).

This act modifies provisions relating to certification of community paramedics and the provision of community paramedic services. Community paramedic services shall mean those services provided by an entity that employs licensed paramedics certified by the Department of Health and Senior Services as community paramedics for services that are provided in a nonemergent setting, consistent with the education and training of a community paramedic and the supervisory standard approved by the medical director, and documented in the entity's patient care plans or protocols.

Any ambulance service that seeks to provide community paramedic services outside of its service area shall have a memorandum of understanding (MOU) with the ambulance service of that area if that ambulance service is already providing those services or shall notify the ambulance services of that area if that ambulance service is not providing community paramedic services. Emergency medical response agencies (EMRAs) may provide community paramedic services in a ground ambulance service's service area. If the ground ambulance service is already providing those services or provides them after the EMRA offers them, then the EMRA and ground ambulance service shall enter into a MOU for the coordination of services.

The Department shall promulgate rules and regulations for the purpose of certifying community paramedic services entities and the standards necessary to provide such services. Certified entities shall be eligible to provide community paramedic services for 5 years.

This provisions is identical to a provision in SCS/HCS/HB 943 (2025) and a provision in SCS/SB 317 (2025), and similar to a provision in SB 548 (2025), SB 206 (2025), and SCS/SB 1382 (2024).

This act modifies the State Advisory Council on Emergency Medical Services by changing the number of council members from 16 to no more than 23 and specifying the members who shall serve on the Council. Currently, members are appointed by the Governor with the advice and consent of the Senate. Under this act, the Director of the Department of Health and Senior Services, the regional EMS advisory committees, and the Time-Critical Diagnosis Advisory Committee shall appoint members.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), and substantially similar to a provision in SCS/SB 317 (2025), SB 548 (2025), SB 206 (2025), SB 270 (2025), SB 1277 (2024), and a provision in SCS/SB 1382 (2024).

The Department of Health and Seniors Services, as a part of regulating ground ambulance service licenses, shall promulgate rules regarding participation with regional emergency medical services advisory committees and ambulance service administrator qualifications.

This act requires ambulance services to report to the Department individuals serving as ambulance service administrators. These administrators shall be required to complete training as described in the act.

The Department may refuse to issue, deny renewal of, or suspend a license required for ground ambulance services or take other corrective actions for reasons specified in the act. If the Department makes a determination of insolvency or insufficiency of services, then the Department may require the license holder to submit and complete a corrective plan, as described in the act.

The Department shall be required to provide notice of any determination of insolvency or insufficiency of services to persons and entities specified in the act. The Department shall immediately engage with other license holders in the area to determine how ground ambulance services may be provided to the affected area during the service disruption. Assisting license holders may be compensated for such assistance as described in the act.

These provisions are identical to provisions in SCS/HCS/HB 943 (2025) and provisions in SCS/SB 317 943 (2025), and substantially similar to provisions in SB 548 (2025), SB 7 (2025), SB 206 (2025), SB 1340 (2024), and provisions in SCS/SB 1382 (2024).

Current law establishing the Ground Ambulance Service Reimbursement Allowance excludes any ambulance service owned or operated by an entity owned and operated by Missouri, including any hospital owned or operated by the University of Missouri Board of Curators. This act removes this exception.

This provision is identical to a provision in SCS/HCS/HB 943 (2025), and SB 629 (2025).

SEXUALLY TRANSMITTED INFECTIONS (Section 191.648)

Currently, a physician may utilize expedited partner therapy, meaning the practice of treating the sex partners of persons with chlamydia or gonorrhea without an intervening medical evaluation or professional prevention counseling, to prescribe and dispense medications for the treatment of chlamydia or gonorrhea even without an established physician/patient relationship.

Under this act, physicians and certain health care professionals may use expedited partner therapy and such therapy may be used for designated sexually transmitted infections beyond chlamydia and gonorrhea. This act repeals the requirement that antibiotic medications prescribed and dispensed through expedited partner therapy for the treatment of chlamydia or gonorrhea be in pill form.

These provisions are substantially similar to provisions in SCS/SB 178 (2025), provisions in SCS/SB 317 (2025), HCS/HB 943 (2025), the perfected HCS/HB 2413 (2024), SB 1445 (2024), and HB 1879 (2024).

TELEHEALTH SERVICES (Sections 191.1145 and 191.1146)

Under this act, "telehealth" or "telemedicine" shall include the delivery of health care services through audiovisual and audio-only technologies and shall not be limited in their choice of electronic platforms, provided that all services delivered are in accordance with HIPAA.

Under the act, establishing a physician-patient relationship through telemedicine only requires an in-person physical examination if the examination required to meet the standard of care. The act requires evaluations, rather than interviews, requires questionnaires to be reviewed by the treating health care professional, and requires the questionnaires to include information sufficient to provide the information as though the medical evaluation was performed in person. Health care providers utilizing medical evaluation questionnaires completed by the patient by way of internet or telephone shall provide a written report to the patient's primary health care provider within 14 days, including certain information detailed in the act.

Additionally, current law requires a physician-patient relationship for purposes of telehealth to include a sufficient dialogue with the patient regarding treatment. This act changes "dialogue" to "exchange" with the patient regarding treatment.

Current law prohibits a health care provider from prescribing any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone, or on an internet request or questionnaire. The act modifies the reference to evaluations over the telephone to include all telemedicine, and specifies that a health care provider shall not prescribe any drug, controlled substance, or other treatment to a patient in the absence of a proper provider-patient relationship.

Medical records of any drug, controlled substance, or other treatment prescribed through telemedicine shall be collected, stored, and maintained in accordance with HIPAA.

These provisions are similar to SB 108 (2025), SB 94 (2025), SB 851 (2024), HB 1873 (2024), SB 931 (2024), SCS/SB 418 (2023), SB 669 (2023), HB 1098 (2023), and HB 710 (2023).

FORENSIC EXAMINATIONS OF VICTIMS OF SEXUAL OFFENSES (Section 192.2521)

Under this act, a specialty hospital, meaning a hospital other than a general acute care hospital, shall not be required to comply with certain statutory provisions relating to forensic examinations of victims of sexual assault if such hospital has in place a policy for the transfer of such victims to an appropriate hospital with an emergency department.

These provisions are identical to provisions in SCS/SB 178 (2025) and provisions in the perfected HCS/HB 2413 (2024), and substantially similar to SB 1326 (2024).

MO HEALTHNET COVERAGE OF HEARING-RELATED DEVICES (Section 208.152)

Currently, reimbursable MO HealthNet services include hearing aids for eligible needy children, pregnant women, and blind persons. This act mandates MO HealthNet coverage of medically necessary cochlear implants and hearing instruments for all eligible participants.

These provisions are identical to SB 419 (2025) and the perfected HCS/HBs 2626 & 1918 (2024), and substantially similar to SB 1443 (2024).

PRENATAL TESTS FOR CERTAIN DISEASES (Section 210.030)

Currently, a physician or other health care provider shall draw and test a pregnant woman's blood at or soon after her first prenatal examination, with her consent, for syphilis, hepatitis B, or other similar diseases. Under this act, the testing of the pregnant woman's blood shall also occur at the twenty-eighth week of her pregnancy and immediately after birth. Additionally, the test shall include hepatitis C and HIV. If a mother tests positive for syphilis, hepatitis B, hepatitis C, or HIV, the physician or other health care provider shall treat the mother in accordance with the most recent accepted medical practice.

Current law requires the Department of Health and Senior Services to work in consultation with the Missouri Genetic Disease Advisory Committee to make rules pertaining to these blood tests. This act repeals the requirement to work with the Committee and requires that the tests be approved or accepted by the U.S. Food and Drug Administration.

Health care providers shall receive informed consent prior to administering any treatment or procedure.

These provisions are substantially similar to provisions in SCS/SB 178 (2025), provisions in SCS/SB 317 (2025), HCS/HB 943 (2025), HCS/HB 2413 (2024), and SB 1260 (2024).

EXAMINATION OF HEALTH MAINTENANCE ORGANIZATIONS (Section 354.465)

This act repeals the requirement that the Department of Commerce and Insurance examine health maintenance organizations at least once every 5 years.

INSURANCE COVERAGE OF SELF-ADMINISTERED HORMONAL CONTRACEPTIVES (Section 376.1240)

This act requires health benefit plans issued or renewed on or after January 1, 2026, that provide coverage for self-administered hormonal contraceptives, as defined in the act, to cover a supply of the contraceptives which is intended to last up to one year.

These provisions are identical to provisions in SCS/SB 178 (2025), provisions in the perfected HCS/HB 2413 (2024), SB 821 (2024), SB 1321 (2024), SB 512 (2023), HB 287 (2023), SB 641 (2022), SB 472 (2021), HB 1373 (2021), and SB 346 (2019).

CONTRACTS FOR HEALTH BENEFITS PROVIDED BY CERTAIN MEMBERSHIP ORGANIZATIONS (Section 376.1850)

This act provides that statutes governing health insurance shall not apply to contracts for health care benefits provided by a qualified membership organization, as such terms are defined in the act, to its members who have been members for at least 30 days, and that the qualified membership organization shall not be considered to be engaging in the business of insurance. Qualified membership organizations providing the contracts shall register with the Department as specified in the act.

Contracts for health services under the act shall be sold, solicited, or negotiated only by insurance producers licensed to produce accident and health or sickness coverage. A qualified membership organization providing contracts as specified in the act shall use the services of a licensed third-party administrator, and shall agree in the contract with the administrator to be subject to certain processes for benefit determinations and claims payment procedures applicable to health carriers and health benefit plans as specified in the act. Contracts for health care benefits shall not be subject to the insurance laws of the state except as provided in the act.

Financial risk under the contracts may be reinsured as provided by law. The contracts and related applications and renewal forms shall bear a disclaimer, as specified in the act, which shall be signed by the organization member.

Contracts under the act shall not be subject to individual post-claim medical underwriting while coverage remains in effect, and members covered by the contracts shall not be subject to cancellation, nonrenewal, modification, or increase in premium for reason of a medical event.

The Division of Consumer Affairs within the Department of Commerce and insurance shall receive and review complaints and inquiries from members of qualified membership organizations, and qualified membership organizations providing contracts under the act shall annually pay a fee to the Department as described in the act.

Lastly, the act requires the qualified membership organizations to pay to the Department of Commerce and insurance a fee equal to 1% of the Missouri claims paid under the contracts during the preceding year, prohibits the organizations from referring to or marketing the contracts as insurance, and requires the contracts to include certain coverage.

These provisions are similar to SB 925 (2024), HB 2082 (2024), SS/SCS/SB 11 (2023), and HCS/HB 464 (2023).

PRIOR AUTHORIZATION OF HEALTH CARE SERVICES (Sections 376.2100, 376.2102, 376.2104, 376.2106, and 376.2108)

This act enacts provisions relating to prior authorization of health care services.

Beginning January 1, 2026, health care providers shall not be required to obtain prior authorization for a health care service unless the health carrier or utilization review entity determines that in the most recent evaluation period, as defined in the act, less than 90% of the prior authorization requests submitted by that provider for that health care service were approved or would have been approved.

Also beginning January 1, 2026, health care providers shall not be required to obtain prior authorization for any health care services unless the health carrier or utilization review entity has approved or would have approved less than 90% of all prior authorization requests submitted by that provider for health care services.

Health carriers or utilization review entities may elect to have certain hospitals determine which of certain conditions, laid out in the act, the hospital will comply with in order to obtain a prior authorization exemption under the act.

Exemptions from prior authorization under the act shall not apply to: pharmacy services, not to exceed the amount of $100,000; imaging services, not to exceed $100,000; cosmetic procedures that are not medically necessary; or investigative or experimental treatments. Maximum dollar amounts for these exceptions shall be adjusted annually for inflation as described in the act.

The act further specifies certain prior authorization requests that shall not be included in making determinations under the act, specifies identification methods for the providers, includes provisions for the auditing and retraction of determinations under the act, allows for health carriers and utilization review entities to require providers to use an online portal to submit prior authorization requests, requires adverse determinations under the act to be reviewed by a clinical peer of the provider, and requires a grace period for patients who have received prior authorization for a 90-day supply of medication.

Health carriers and utilization review entities shall notify providers within 25 days after a determination is made under the act, shall include in the notification certain information used in making the determination, shall establish an appeals process for the providers, and shall maintain an online prior authorization portal as described in the act.

No health carrier or utilization review entity shall deny or reduce payment to a health care provider for a health care service for which the provider has prior authorization, except as described in the act.

These provisions shall not apply to MO HealthNet services not provided through a managed care organization, or to providers who have not participated in a health benefit plan offered by the health carrier for at least one full evaluation period.

These provisions are identical to HB 618 (2025), and similar to SB 230 (2025), SB 983 (2024), HB 1976 (2024), SB 576 (2023), and HB 1045 (2023).

MAMMOGRAMS (repeal of Section 192.769)

This act repeals a provision of current law requiring the provision of a specific notice to patients upon the completion of a mammogram.

These provisions are identical to provisions in SCS/SB 178 (2025), provisions in the perfected HCS/HB 2413 (2024), and SB 1328 (2024).

ERIC VANDER WEERD